Category: 2025

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: 2025 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

DISCUSSION:

Effective April 1, 2025, MAGI cases will be updated to reflect a 2.5% COLA for Social Security Administration (SSA) and Supplemental Security Income (SSI) participants.

Cases Adjusted

Cases that include income types Social Security Adult (disability or received off disabled/deceased spouse), Social Security Adult (retirement), Social Security Child (disability or received off disabled/deceased parent), and SSI are subject to an automatic increase of 2.5%. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Cases That Did Not Adjust

Some cases will not adjust during COLA. These cases will require manual intervention from staff to add the increased income amounts. As cases are reviewed, check the income on each case to determine if the current income is entered. Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, the eligibility system will finalize the decision(s) and send out the appropriate notices.

Note: Due to the Continuous Eligibility requirement during the Transition Period, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

MA/vh

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: NURSING HOME COVERAGE FOR PARTICIPANTS ON QUALIFYING MODIFIED ADJUSTED GROSS INCOME (MAGI) LEVELS OF CARE

MANUAL REVISION #
0815.005.00
0815.030.00
1040.010.00
1040.015.15 
1040.020.10 
1040.020.40.15
1040.020.40.20 

DISCUSSION:

Participants on MAGI levels of care, with the exception of Uninsured Women’s Health Services (UWHS) and Extended Women’s Health Services (EWHS), can qualify for nursing home services if they meet specific medical criteria. The medical certification for these individuals is made by the Department of Health and Senior Services (DHSS). Participants eligible for nursing home services under MAGI levels of care are subject to transfer penalties but are not subject to resource limits or a surplus.

The Family Support Division (FSD) Nursing Facility (Vendor) Unit is notified when a participant meets the medical criteria for nursing home services. A new piece of evidence, MO Vendor Facility, has been added to the Missouri Eligibility Determination and Enrollment System (MEDES). This evidence provides the Nursing Home (Vendor) Unit a streamlined way to notify MO HealthNet Division (MHD) when individuals on MAGI levels of care meet the criteria for nursing home services.

There is no change in how MAGI staff process applications. The requirement, for participants claiming a disability and approved for Adult Expansion Group (AEG) coverage to also have eligibility explored for Mandatory Non-MAGI programs, has not changed. See Appendix K to determine which levels of care are considered mandatory.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

MA/rc

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: 2025 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

MANUAL REVISION #
APPENDIX A
APPENDIX A (PE)
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX I

FORM REVISION#
IM-4PRM

DISCUSSION:

Effective April 1, 2025, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).
MAGI cases were adjusted on February 22, 2025 based on the new FPL income guidelines. Changes in circumstance or applications processed prior to April 1, 2025 will need to be authorized before the FPL change can be viewed.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to:

• become eligible as a non-premium case;
• go from CHIP75 to CHIP74; or
• go from CHIP74 to CHIP73.

The refund process will take approximately 8 weeks to complete.

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2025 through March 31, 2026.

NECESSARY ACTION:

• Use the new FPL income guidelines beginning April 1, 2025
• Review this memorandum with appropriate staff.

MA/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO 1619 THRESHOLD

MANUAL REVISION #
Appendix J

DISCUSSION:

The threshold amount established by the Social Security Administration (SSA) to determine eligibility under Section 1619 of the Social Security Act has increased to $4,198 effective January 1, 2025. Additional information regarding 1619 eligibility is available in manual section 0850.005.20 Financial Need.

Eligibility Standards for Non-MAGI Programs (Appendix J) of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual was updated to reflect the new threshold.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #
APPENDIX J
APPENDIX N

DISCUSSION:

The average private pay nursing care rate increased to $7,909 per month effective April 1, 2025. For applications taken on or after April 1, 2025, use $7,909 to determine the number of months of ineligibility for vendor level services for a transfer of assets penalty.

Eligibility Standards for Non-MAGI Programs (Appendix J) of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual lists the current average private pay nursing care rate.

Note: Maximum MMMNA was incorrect on the 12/2024 revision of the Eligibility Standards for Non-MAGI Programs appendix and has been corrected. The correct monthly amount is $3948 effective 1/1/2025.

Average Private Pay Nursing Home Rates (Appendix N) of the December 1973 Eligibility Requirements Manual lists the historical values for average private pay nursing care rates.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: NON-MAGI FEDERAL POVERTY LEVEL ADJUSTMENT

MANUAL REVISION #
Appendix J
Appendix K

DISCUSSION:

Effective April 1, 2025, the Federal Poverty Level (FPL) income guidelines increase for the following programs:

• MO HealthNet Non-Spend Down (MHNS)
• MO HealthNet Spend Down (MHSD)
• Ticket to Work Health Assurance (TWHA)
• Qualified Medicare Beneficiary (QMB)
• Specified Low Income Medicare Beneficiary (SLMB and SLMB2)
• Qualified Disabled Working Individuals (QDWI)
• MO HealthNet for Disabled Children (MHDC)
• Blind Pension (BP)

The weekend of March 8, 2025, programs with income eligibility based on the federal poverty level will be adjusted in the eligibility system.

Note: All MO HealthNet cases will be adjusted based on the new FPL income guidelines.

Premium Refunds

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

Program Descriptions

Appendix K in the Non-MAGI Policy Manual is updated to include the change in FPL income limits.

Income Standards

Appendix J in the Non-MAGI policy Manual is updated with the updated FPL income limits.

All FPL income guidelines are effective from April 1, 2025, through March 31, 2026. These standards may be referenced as needed for historical purposes.

MHABD income standards

QDWI income standards

Medicare Savings Programs income standards

Blind Pension sighted spouse monthly income maximum

TWHA Income Standards and Premiums

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using the new FPL income guidelines for eligibility determinations effective April 2024 and ongoing.
• Follow the staff user guides in IM Resources to resolve conflicting actions related to FPL.
• Review this memorandum with appropriate staff.

KE/st